Spotlight on patient centred care

The BMJ Spotlight: Patient Centred Care

This spotlight series of articles on patient centred care explores how doctors and patients can work collaboratively to improve the way healthcare is designed and delivered so that it better meets the needs and priorities of patients.

Empowered patients are driving a social movement and spearheading a shift in roles “as profound as women’s liberation, racial equality, gay rights, and disability rights”.

They are capable and motivated to help themselves and other patients to get better care and work with health professionals to improve services which are not well geared to meet the challenge of demographic change and the rise in number of people living with long term conditions where it is important that people take on a greater role in self managing their health and medical conditions.

The spotlight series is another step in the development of The BMJ’sPatient Partnership strategy and brings together analysis and comment from doctors, patients, carers, and community representatives to help inform, inspire and spur change.

It was supported by DNV GL and edited by Tessa Richards, Angela Coulter, and Paul Wicks. The articles were commissioned and peer reviewed according to the The BMJ's normal processes. Competing interests are available here.

Time to deliver patient centred care
Patient centred care is central to the mission of healthcare, yet traditonally neither patients nor the public have the power to shape the services they use and pay for, or define their value. As a result, many patients find services difficult to navigate, disempowering, burdensome, and seemingly designed to frustrate.

New South Wales mounts “patient based care” challenge
The Clinical Excellence Commission in New South Wales is driving person centred care by stimulating districts to compete to provide it. Karen Luxford and Stephanie Newell describe the integrated approach, its uptake, and encouraging early evidence of change.

Amir Hannan
“Our experience has shown that it is not sufficient to provide patients with viewing rights. They need to understand the content of their records too. This has been helped by an explicit consent model”

Maria Hägglund & Sabine Koch
“Health information, contact details of providers, and interactive services where they can ask questions anonymously that are answered within seven days”

Delivering person centred care in long term conditions
Transforming care for people with long term conditions, including support for self management, requires comprehensive reform of health systems largely geared to provide acute care. Simon Eaton, Sue Roberts, and Bridget Turner explore the barriers to change, arguing that the success of new approaches will depend on whole system change and strong leadership.

Commentaries

Alex Silverstein
"I now feel I can manage my health independently except in a crisis. However, I am still requested to go to the hospital once every six months for an appointment that may not be needed."

Adam Gordon
“The current focus on person centred care runs the risk of overemphasising independence and stigmatising dependence and interdependence - which are facts of life for many older patients.”

Martin Wilkie and colleagues
“Shared haemodialysis care does require flexibility in units where traditionally services have been set up to ‘do things to patients.’”

Dominick L Frosch
“I want to be recognised as the most important member of the team: the one who know most about living with this disease.”

Patient reported outcome measures in practice
Scores of tools to measure outcomes that matter to patients have been developed over the past 30 years but few are used routinely at the point of care. Eugene C Nelson and colleagues describe examples where they are used in primary and secondary care and argue for their wider uptake to improve quality of care.

From patient centred to people powered: autonomy on the rise
Following in the path of feminists and civil rights leaders, informed patients are building a progressive social movement to improve medical care. Dave deBronkart says medicine should let patients help improve care, share responsibility, and think for themselves.

Decision aids that really promote shared decision making: the pace quickens
Decision aids can help shared decision making, but most have been hard to produce, onerous to update, and are not being used widely. Thomas Agoritsas and colleagues explore why and describe a new electronic model that holds promise of being more useful for clinicians and patients to use together at the point of care.

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